WATER-BASED FIRE PROTECTION SYSTEM Acceptance Inspection/Test Request

WATER-BASED FIRE PROTECTION SYSTEM
Acceptance Inspection/Test Request
Fairfax County Office of the Fire Marshal, Fire Protection Systems Branch, 10700 Page Avenue, Fairfax, VA 22030
Phone - 703-246-4821, TTY 711, Fax - 703-246-6041
Permit / AP # _________________________________ Review ID old system only ______________________
Today’s Date: ___________/_______/_______
Company: ____________________________________________________________________________
Phone No: ________ - _______ - __________
Requesters Name: _____________________________________________________________________
Fax No: _________ - ________ - __________
Email Address: ________________________________________________________________________
Project Address: __________________________________________________ Building: _______________________________ Floor / Suite: ______________________
Tenant Name:
__________________________________________________ Project Name: __________________________________________________________
Completion / Request Date: ________/_______/________ Options: __________________________________ Time Requested:
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Estimated Inspection Time Check one
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15-Minute Inspection
30-Minute Inspection
45-Minute Inspection
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1-Hour inspection with 1-inspector
2-Hour inspection with 1-inspector
AM
PM
4+ hour inspection with 2-inspectors
Overtime Inspection
2-Hour inspection with 2-inspectors
Type Test Check One
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UG Visual
UG Visual & Hydro
UG Hydro
*(check below)
*(check below)
UG Hydro & Flush
UG Flush)
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*(check below)
*(check below)
*(check below)
UG Visual, Hydro & Flush
*(check below)
Sprinkler Hydro
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Standpipe Hydro
FDC Hydro
Bulk Pipe Hydro
Fire Pump Test
Trip Test
Standpipe Flow/ Flush
Main Drain Test
Sprinkler Visual
Final Walk
15-minute Hydro
13-R Booster Pump
Preaction
24-Hour Air Test
Other____________________________________________________________________ ____________________________________________
* Check portion of UG Fireline to be inspected
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Portion of UG Fireline from street valve to five feet outside building.
Portion of UG Fireline from five feet outside building to first flange inside.
Entire UG Fireline from street valve to first flange inside building.
Scheduled Test Date __________/_________/ 20______ @ ________________
Inspector __________________/_______________
or will call with a 2-hour time frame
Scheduled by Inspector __________________